Provider Demographics
NPI:1912425695
Name:FLANNIGAN, VICKI (LPN)
Entity Type:Individual
Prefix:
First Name:VICKI
Middle Name:
Last Name:FLANNIGAN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:VICKI
Other - Middle Name:
Other - Last Name:FLANNIGAN ALEXANDER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4560 CATLIN DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44143-2535
Mailing Address - Country:US
Mailing Address - Phone:216-862-5497
Mailing Address - Fax:
Practice Address - Street 1:4560 CATLIN DR
Practice Address - Street 2:
Practice Address - City:RICHMOND HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44143-2535
Practice Address - Country:US
Practice Address - Phone:216-862-5497
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-01
Last Update Date:2017-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN141468164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse